title: The Relationship between Preoperative Wound Classification and Postoperative Infection: A Multi-Institutional Analysis of 15,289 Patients.
abstract: BACKGROUND
  Despite advances in surgical techniques, sterile protocols, and perioperative antibiotic regimens, surgical site infections (SSIs) remain a significant problem. We investigated the relationship between wound classification (i.e., clean, clean/contaminated, contaminated, dirty) and SSI rates in plastic surgery.
  
  
  METHODS
  We performed a retrospective review of a multi-institutional, surgical outcomes database for all patients undergoing plastic surgery procedures from 2006-2010. Patient demographics, wound classification, and 30-day outcomes were recorded and analyzed by multivariate logistic regression.
  
  
  RESULTS
  A total of 15,289 plastic surgery cases were analyzed. The overall SSI rate was 3.00%, with superficial SSIs occurring at comparable rates across wound classes. There were similar rates of deep SSIs in the clean and clean/contaminated groups (0.64%), while rates reached over 2% in contaminated and dirty cases. Organ/space SSIs occurred in less than 1% of each wound classification. Contaminated and dirty cases were at an increased risk for deep SSIs (odds ratios, 2.81 and 2.74, respectively); however, wound classification did not appear to be a significant predictor of superficial or organ/space SSIs. Clean/contaminated, contaminated, and dirty cases were at increased risk for a postoperative complication, and contaminated and dirty cases also had higher odds of reoperation and 30-day mortality.
  
  
  CONCLUSIONS
  Analyzing a multi-center database, we found that wound classification was a significant predictor of overall complications, reoperation, and mortality, but not an adequate predictor of surgical site infections. When comparing infections for a given wound classification, plastic surgery had lower overall rates than the surgical population at large.
authors.affiliation: Department of Plastic Surgery, Vanderbilt School of Medicine, Nashville, TN, USA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Mioton
authors.forename: Sumanas W
authors.initials: SW
authors.lastname: Jordan
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Hanwright
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.forename: John Ys
authors.initials: JY
authors.lastname: Kim
keywords: Plastic surgery; Postoperative complications; Wound infection